Summaries of health policy coverage from major news organizations

Op-Ed Criticizes Invasive Insurer Questionnaires

Recounting their experience in purchasing group health insurance for the employees of Public Citizen, Alan Morrison, director of the Public Citizen Litigation Group, and Sidney Wolfe, director of the Public Citizen Health Research Group, raise concerns about medical privacy and insurer "discrimination" against companies with unhealthy employees in a Washington Post op-ed. When Public Citizen requested bids from insurance companies, it received questionnaires requiring detailed medical histories of employees including "highly personal matters such as alcohol/drug abuse, infertility, immune system disorders (such as AIDS) and any psychological diseases or disorders." The authors write that they did not have the requested information and decided they would not ask their employees for it, since employers "access to that kind of highly private information ... could be used, legally or not, to the disadvantage of the employee who is forced to provide it." The experience was "particularly distressing," because although "Public Citizen is a well-known consumer advocacy organization that might be expected to resist this kind of personal interrogation," other companies "may be less concerned about protecting the medical records of their employees."

Avoiding Risk

The authors write that the episode also "illustrates how the business of medical insurance in America works today." They write, "The use of these forms ... makes clear that insurance companies are doing their best not to sell insurance, but to sell prepaid services to people who are unlikely to need much medical treatment or, at worst, who will only need fairly predictable and inexpensive services." Instead of "spreading risk" among a pool of people, insurers are now "avoiding risk" by charging higher prices to employers with sicker employees. Although The Health Insurance Portability and Accountability Act (HR 3103) passed by Congress in 1996 aimed to prevent insurance companies from refusing coverage of individuals with potentially expensive preexisting conditions, the authors argue that the law is an "experiment [that] has been largely unsuccessful." Though the law prevents charging higher rates for sicker workers, it "expressly allows" insurance companies to raise the rates of groups. This does not eliminate discrimination, Morrison and Wolfe write, but rather "shifts the costs to a somewhat larger group -- but not the entire community." Further, the law does not protect individuals who are not part of a group from "having to pay outrageous amounts" to purchase coverage guaranteed them under the law.

Solutions

Options that Congress could consider to alleviate these problems, the authors write, include a "regime" to control health care prices, which would include "new rules and regulations for insurance companies, hospitals, doctors, companies that sell products and services to them." But Morrison and Wolfe note that eliminating a system based on "shopping around for insurance coverage," and creating one in which "health care providers treated whoever came in the door and were paid accordingly," would solve the "problem of group dumping." Morrison and Wolfe conclude by saying that even though "the gods of conventional wisdom" in the United States have removed national health insurance as an option, if citizens believe that "group dumping -- and other similar flaws in the current system" -- should be prevented, they should not "dismiss" a single-payer system unless they "have something else that will do the job as well" (Morrison/Wolfe, Washington Post, 1/7).

This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.